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OASIS-C. Clinical Record Issues Contact: Cindy Skogen, RN ( OEC ) 651-201-3818, or health.oasis@state.mn.us for questions. Source: Center for Medicare and Medicaid Services. M0080 Discipline of Person Completing Assessment. 1-RN 2-PT 3-SLP/ST 4-OT

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oasis c
OASIS-C

Clinical Record Issues

Contact: Cindy Skogen, RN (OEC)

651-201-3818, or

health.oasis@state.mn.us for questions.

Source: Center for Medicare and Medicaid Services

Clinical Record Issues

m0080 discipline of person completing assessment
M0080 Discipline of Person Completing Assessment
  • 1-RN 2-PT 3-SLP/ST 4-OT
  • Only one individual completes the comprehensive assessment:

- If more than one discipline involved in case

  • Care consultation/coordination is needed
  • But only one actually completes &records assessment

Clinical Record Issues

m0080 discipline of person completing assessment cont
M0080 discipline of Person Completing Assessment (cont.)
  • RN & PT/SLP ordered at initial referral, the RN must complete SOC comprehensive assessment
  • LPN’s, PTAs, COTAs, MSWs, & HHAs not authorized to complete comp assessments
  • Last qualified clinician to see patient at DC completes the DC assessment

Clinical Record Issues

m0090 date assessment completed
M0090 Date Assessment Completed
  • (M0090) Date Assessment Completed:
  • _ _/_ _/ _ _ _ _
  • Month/date/year
  • Actual date the assessment is completed
  • M0090 cannot be before the SOC date
  • If agency policy allows assessments to be completed over more than one visit date –M0090 =the last date-when the final assessment data is collected

Clinical Record Issues

m0090 date assessment completed cont
M0090 Date Assessment Completed (cont.)
  • Record date data collection completed after learning of event:
  • -Transfer to Inpatient Facility; no agency DC

-Transfer to Inpatient Facility: patient DC from agency

-Death at home

  • A visit is not necessarily associated with these events

Clinical Record Issues

m0100
M0100
  • (M0100) This assessment is Currently Being Completed for the Following Reason:

Start/resumption of Care

  • 1-/start of care-further visits planned
  • 3-Resumption of Care (after inpatient stay)

Follow up

  • 4-Recertification (follow up) reassessment {Go to M0110}
  • 5-Other follow-up {Go to M0110}

Transfer to an Inpatient Facility

  • 6-Transferred to an inpatient facility-pt not DC from agency {Go to M1040}
  • 7-Transferred to an inpatient facility-pt DC from agency {Go to M1040}

Discharged from Agency-Not to an Inpatient facility

  • 8-Death at home {Go to M0903}
  • 9-DC from agency {Go to M1040}

Clinical Record Issues

m0100 cont
M0100 (cont.)

Start/resumption of care

1-Start of Care-further visits planned

3-Resumption of care (after inpatient stay)

Follow-Up

4-Recertification (follow-up) reassessment [Go to M0110]

5-Other follow-up [Go to M0110]

Clinical Record Issues

m0100 cont8
M0100 (cont.)

Transfer to Inpatient Facility

  • 6-Transferred to an inpatient facility-pt not discharged from agency [Go to M1040]
  • 7-Transferred to an inpatient facility-pt d/c from agency [Go to M1040]

Discharge from Agency-Not to an Inpatient Facility

8-Death at home [Go to M0903]

9-Discharged from agency [Go to M1040]

Clinical Record Issues

m0100 cont9
M0100 (cont.)
  • Assessment/data collection time points
  • Reason why the assessment data are being collected and reported

-reason for assessment (RFA)

  • Data reporting software accepts or rejects certain data based pm the M0100 response

-Accuracy critical

Clinical Record Issues

rfa 1 start of care
RFA 1: Start of Care
  • Must be conducted during a home visit
  • Comprehensive assessment completed when the POC established

-Whether or not further visit will be provided after the SOC visit

-Appropriate response anytime a HHRG is required

Clinical Record Issues

rfa 3 roc
RFA 3: ROC
  • Must be conducted during a home visit
  • Resumption of care (ROC) comprehensive assessment
  • Performed when resuming care of patient

-following inpatient stay of 24 hrs. or longer

-for reasons other than diagnostic testing

Clinical Record Issues

rfa 3 roc cont
RFA 3: ROC (cont.)
  • If resuming care during last 5 days of the episode following inpatient discharge

-Perform ROC not a Recertification (RFA 4)

Answer payment questions as if Recert

-This assessment establishes payment code for next 60-day episode

Clinical Record Issues

rfa 4 recertification
RFA 4: Recertification
  • Must be conducted during a home visit
  • Comprehensive assessment during last 5 days of the 60-day cert period

-Need to continue services for additional 60-day episode of care

  • If HHA misses recert window

-Make a visit as soon as possible

-Explain in clinical documentation

Clinical Record Issues

rfa 5 other follow up
RFA 5: Other Follow-up
  • Must be conducted during a home visit
  • Comprehensive assessment due to a major decline or improvement in health status

-At any time other than during the last 5 days

-HHA should have policy

  • Reevaluation of patient’s condition

-Allowing revision of POC, as appropriate

Clinical Record Issues

rfa 6 transfer no dc
RFA 6: Transfer; No DC
  • Data collection completed when:

-Admitted to inpatient facility bed for 24 hrs or more

-For reasons other than diagnostic test

  • Exception that home care will be resumed following discharge from facility

Clinical Record Issues

rfa 6 transfer no dc cont
RFA 6: Transfer; No DC (cont.)
  • Short stay observation periods in a hospital do not count as a transfer

-regardless of duration

  • Not a comprehensive assessment-does not require a home visit

-May gather information via telephone

  • If hospitalization discovered during home visit, need transfer (RFA 6) and ROC

Clinical Record Issues

rfa 7 transfer dc
RFA 7: Transfer & DC
  • Data collection completed when:

-Admitted to inpatient facility bed for 24 hrs or more

-For reasons other than diagnostic test

  • No plan to resume care of patient
  • No additional OASIS DC data required
  • Short stay observation periods in a hospital do not count as a Transfer

-Regardless of duration

Clinical Record Issues

rfa 7 transfer dc cont
RFA 7: Transfer & DC (cont.)
  • Also completed when patient dies:

-In ER

-In inpatient bed before stay of 24 hours

(M0906 guidance)

Clinical Record Issues

rfa 8 death at home
RFA 8: Death at Home
  • Data collection-not assessment
  • Patient dies before being treated in an ER or before being admitted to an inpatient facility

Clinical Record Issues

rfa 9 discharge
RFA 9: Discharge
  • Comprehensive assessment when patient discharged from agency

-For reasons other than death or transfer to inpatient facility

-An actual patient interaction, a visit, is required

  • Complete when you transfer and discharge to another HHA or an in-home hospice

Clinical Record Issues

unplanned or unexpected discharge
Unplanned or Unexpected Discharge
  • If discharge is unplanned, requirement must still be met
  • Discharge assessment must report patient status at an actual visit
  • Assessment data should be based on the last visit conducted by a qualified clinician

Clinical Record Issues

m0102
M0102
  • (M0102) Date of Physician-ordered Start of Care (Resumption of Care): If the physician indicated a specific start of care (resumption of care) date when the patient was referred for home health services, record the date specified.
  • _ _/_ _/ _ _ _ _
  • Month/date/year
  • {Go to M0110, if date entered}
  • NA – No specific SOC date ordered by physician

Clinical Record Issues

m0102 cont
M0102 (cont.)
  • Date of physician-ordered SOC/ROC

-If MD indicated a specific date on referral

-If date entered, skip M0104 Date of referral and go to M0110 Episode Timing

-Mark NA: If initial orders do not specify a SOC date

  • If the originally ordered SOC is delayed for any reason

-Report the date on the updated or revised order

Clinical Record Issues

m102 cont
M102 (cont.)
  • Referral from a facility is made on behalf of the physician and is considered for M0102
  • Date must be specific, not ranges (i.e., 1-2 days following hospitalization)

Clinical Record Issues

m0104
M0104
  • (M0104) Date of Referral: Indicate the date that the written or verbal referral for initiation or resumption of care was received by the HHA.
  • _ _/_ _/_ _ _ _
  • Month/day/year

Clinical Record Issues

m0104 date of referral
M0104: Date of Referral
  • Most recent date verbal, written or electronic authorization to begin care was received by HHA
  • If SOC is delayed for any reason, driven by patient’s condition of MD request
  • -Report the date HHA received updated/revised referral information
  • Does not refer to calls from ALF or family preparing HHA for possible admission

Clinical Record Issues

m0110
M0110
  • (M0110) Episode Timing: Is the Medicare home health payment episode fro which this assessment will define a case mix group an “early” episode of a “later” episode in the patient’s current sequence of adjacent Medicare home health payment episodes?
  • 1 -early
  • 2 -later
  • UK -unknown
  • NA -Not applicable: No Medicare case mix group to be defined by this assessment

Clinical Record Issues

m0110 episode timing
M0110: Episode Timing
  • PPS payment item

-Also used by non-PPS payers using a PPS-like payment model

  • Identifies placement of the current MC payment episode in the patient’s current sequence of adjacent MC PPS payment episodes

Clinical Record Issues

m0110 episode timing cont
M0110: Episode Timing (cont.)
  • Sequence of adjacent MC PPS payment episodes = a continuous series of MC PPS payment episodes

-Regardless of whether the same HHA provided care for the entire series

-Low utilization payment adjustment (LUPA) episodes (less than 5 total visits) and Partial Episode Payments (PEP) included

-Denied episodes are not included

Clinical Record Issues

m0110 episode timing cont30
M0110: Episode Timing (cont.)
  • Adjacent means there was no gap between MC-covered episodes of more than 60 days

-care under HMO, MA or private payer = gap days when counting the sequence of MC episodes

Clinical Record Issues

m0110 episode timing cont31
M0110: Episode timing (cont.)
  • “1-Early” selected if this is:

-The only PPS episode in a single episode case

Or

-The first or second PPS episode in a sequence of adjacent MC home health PPS payment episodes

Clinical Record Issues

m0110 episode timing cont32
M0110: Episode Timing (cont.)
  • “2-Later” selected if this is:

-The third or later PPS episode in a current sequence of adjacent Medicare home health PPS payment episodes

  • “UK – Unknown” selected if:

-The placement of this PPA payment episode in the sequence of adjacent episodes is unknown

-For payment, this will have the same effect as selecting the “Early” response

Clinical Record Issues

m0110 episode timing cont33
M0110: Episode Timing (cont.)
  • Enter “NA” if no Medicare case mix group is to be defined for this episode
  • If you select “NA” you cannot generate the PPS payment code (HIPPS/HHRG)
  • Some non-MC payers will use this information in setting an episode payment rate

Clinical Record Issues

counting days manually
Counting Days Manually
  • An MC payment episode ordinarily comprises 60 days beginning with SOCdate, or 60 days beginning with recertification date
  • There can be a gap of up to 60 days between episodes in the same sequence
  • To determine if adjacent count from the lastday of one payment episode (Day 0) until the first day of the next
  • If you count 60 or less = adjacent episode

Clinical Record Issues

counting days manually cont
Counting Days Manually (cont.)
  • A sequence of adjacent MC payment episodes continues as long as there is no 60-day gap, even if MC episodes are provided by different home health agencies
  • Episodes with HMO’s, Medicaid, or private payers do not count as part of a sequence-they are part of the gap between PPS episodes
  • If the period of service with those payers is 60 days or more, the next MC home health payment episode would begin a new sequence

Clinical Record Issues

slide36
Questions???E-mail: health.oasis@state.mn.us

Cindy Skogen, RN;

Oasis Education Coordinator

651-201-3818

Clinical Record Issues